Defender3's PCa Journey - Or, How I Learned to Stop Worrying and Love ED!

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Regular Member

Date Joined Nov 2009
Total Posts : 98
   Posted 11/8/2009 8:58 PM (GMT -6)   
I thought I'd take the suggestion of a couple of folks and start to document, in a single thread, my PCa journey. I'll start by saying I served 27 years in the USAF (Security Forces) retiring in 2003 off the general staff in the Pentagon. I now work for a large defense contractor in the DC area. I have a wonderful wife and three great kids, two cats and two dogs (all rescued). I believe everything in life can, somehow, be related to either football (that's American football) or Star Trek. I enjoy old movies, hence the title of my thread which is a rip-off of Dr. Strangelove, and collect WWII M1 Garands. I have ups and downs, just like everyone else and thought, until recently, I was somewhat incinvible. So, with all that said, it's time to start the path to recovery! P.S. Forgive me if I tend to ramble, I never seem to be at a loss for words

November 8, 2009: Well, looks like I get to join the PCa club! After watching FloMax commercials for a year I finally decided that the low flow was me and went for a general checkup in August in order to get a prescription - it NEVER entered my mind, as a 52 year old healthy man, that I could have cancer. My Doctor did a routine blood test, and a DRE that confirmed the inflamation. He questioned me about symptons, nope, no back pain, blood in the urine, etc. A week later I received a call asking me to come back in to discuss a higher than normal PSA. In I went and found my PSA was 8.7. Even then I wasn't really worried since a number of factors could affect the test, but I was scheduled to visit a Urologist a couple of weeks later in their Stafford offices. I had to cancel that appointment due to work and was rescheduled. When I met with the Urologist, he expalined the PSA to me and that there was another indicator in my blood serum that had him concerned and that I should have another DRE and a biopsy. He did the DRE in the office and told me that there were some hard or calcified spots that warranted additional testing through a biopsy. Okay - starting to get a bit worried now. I stopped by the wellness pharmacy and picked up a double pack of Fleets (enema) which is administered the morning of the biopsy. The wife laughed at me when I asked for her "help" and told me I was on my own! Not really an issue administering the enema, but I can say that it did work and it did work quickly! I went to the main Urology Associates of Fredericksburg office for the biopsy. Clothes off, up on the examining table, onto my side with the knees up. Ultrasound goes in and then a few locals. Then the fun begins with the first needle ( the local hadn't quite taken effect yet - boy, that gets your attention), then 11 more needles (good thing I researched the procedure ahead of time since the Doctor did not tell me what the procedure entails or how the procedure is performed). What a mental journey that was with the nurse "cocking" the needle each time and me there thinking, okay, only 11 more to go, only 10 to go, only 9 to go, etc! It doesn't hurt after that first one, but it's still in your head! I waited two weeks for the results and had my follow on consultation November 3rd. My Urologist was professional and told me there were malignancies and that I had cancer. Okay - that got my attention. Of 12 cores sampled, I had cancer in 4 with a Gleason of 3+3=6 (1 of 3 cores involving 2% in the right apex, 1 of three cores involving 20% in the right mid, and 2 of 3 cores involving 15% in the right base - forget to ask what stage though). I'm a pragmatic person, so I may have taken the Doctor a bit by surprise since I basically accepted the results and asked about the next steps. The medical assistant scheduled me for a CT scan, which I just completed on the 6th (gave me a great disc with hundreds of pictures, too bad I don't know what I'm looking at!) and I have a bone scan scheduled for the 13th. Then I'll have a follow-on consultation on the 1st of December.

So, lots of reading and research to do so the wife and I can decide on a treatment. Lots of questions, but most will wait until the consult with the Urologist on the 1st. While I want this out of me, it may be early enough where the differing treatments have the same level of success (need to get that stage form the Doc). A couple of inital questions for the audience though:

1. If your in the NoVA area, drop me an e-mail or leave a reply since I will probably want a good recommendation for a Doctor. While I appreciate the Urologist I have now, with all the professionals in this area, it would be short-sighted to overlook all options.

2. Do all Urologists have Frankenstein like hands? Can't we get people with little baby fingers?

Hints, tips and advice always welcome!


November 6, 2009: I had my CT scan at Medical Imaging of North Stafford. I had already picked up my barium sulfate drinks (2 - I selected the Berry flavor) and took them at 2 and 1 hour before the test. The stuff is horrible, no matter the flavor. It took me 10 minutes to drink each. Note to self - the internet is your friend and I should have done my research - the sulfate is designed to go through you! I got to the windwo and told the ladies I couldn't hold that stuff in any longer. They chuckled and commented that it's supposed to and that the Doctor should have told me. Off to the men's room where I spent 17 minutes "evacuating!" I guess that's why they tell you to be a half an hour early. The first tech inserted the catheter in my arm and dropped me off with the tech who did the scan. She positioned on the table and told me that she'd be injecting me with contrast solution and that I'd have a wonderful feeling of warmth and not to worry, I wouldn't really pee on myself. She asked me a few questions then the scan was completed. Off to the waiting room where I awaitied the CD with the scan itself. 15 minutes later I had a disk in hand with hundreds of images of my pelvic area. Back home for some research on what the images should look like - I'm not a Doctor, but I did stay in a Holiday Inn last night - useless thought though - let's wait and hear what the doctor has to say.

November 8, 2009: I ordered six books through the HealingWell site that I thought would be helpful as I try to decide what treatment I should undertake. I ordered:
A Primer on Prostate Cancer - The Empowered Patient's Guide by Stephen Strum
Give Yourself a Second Opinion - Dr. Patrick Walsh's Guide to Surviving Prostate Cancer by Patrick Walsh
What Your Doctor May Not Tell You about Prostate Cancer by Glenn Bubley
Dr. Peter Scardino's Prostate Book by Peter Scardino
The Prostate Cancer Treatment Book by Peter Grimm
Saving Your Sex Life by John Mulhall and,
I received the Complete Guide to Prostate Cancer by Peter Bostwick from my Urologist
As of this update, I've completed the book by Bubley and am 3/4 of the way done with Walsh's book.

November 13, 2009: Okay, time for the Bone Scan. Off to Mary Washington Hospital in Fredericksburg for the scan. Checked in at the desk and answered some questions, filled out the obigitory and ubiguitous forms, then sat down to notice I was, with one exception, the youngest in the queue. I was escorted into the treatment room where Dimetri shot a small dose of the radioactive tracer into me and asked I come back in 2 1/2 hours. Off the NTW to have the tires rotated and balanced. I swear there were only two people in the place and it took an hour and a half to get them done. Anyways, it wasn't like I had anything else to do, so I got some good reading time in. I went back in for the scan and it too was a pretty simple procedure - layback and don't move. The scan was over in about 35 minutes, then it was off to the waiting room again to request a copy of the scan and the dictated results. I was able to pick them up on the 14th and the results were favorable: "There is no evidence of focal abnormal accumulation to suggest osseous matastic disease." The scan was also compared to the CT to determine these results.

November 15, 2009: I decided that my lifestyle needs to change a bit so I can be ready to fight this regardless of how early my detection was and the seemingly favorable outcome I should expect given early detection. I started on a multi-vitamin that targets prostate health with certain increased dosages of seemingly helpful vitamins such as D3. I'll also be drinking more water and juices (such as pomegranate) even if that's only a marginal step. I asked the wife to help by forcing me to reduce my red meat intake and yes, I may actually even eat my brocolli now. More exercise too, so it's time to get the equipment in the basement dusted off and ready again - I'd like to lose 20lbs by the 1st of the year as well as tone up again so I reduce my BMI and flabbyness.

I'm really leaning towards surgery at this point, mostly due my age, the reading I've done so far, the ability to have options for salavage if needed and the supposed side effects of other treatments, such as seeds and the research indicating, over time, the occurrance of incontience and impotence increases. I have to say that I'm also surprised that long-term study data just doesn't seem to be there on some of the other therapies, hence my current rationale for surgery. I'll continue to write more though as I mature my research.
I've completed Bubley's book and found it to be an informative resource that lists many differing topics/issues in a single volume. I believe, through research, you will eventually find everything the book covers, but having it in one resource is helpful.

I've completed Walsh's book and found it to be an excellent resource. While Walsh is clearly an advocate of surgery, he covers, with details, a wide range of issues associated with PCa that provide additional research and data points. He covers Johns Hopkins studies that are helpful but that also point our that we are still learning about this disease and its treatment. Two thumbs up for this book.

November 21, 2009:

I completed Scardino's book and found it to also be an excellent resource. Now that I'm doing more and more research, some of the information presented I found in other research or references, but I enjoyed the fact that the Doctor explained all the treatment options along with their side effects.

I completed Grimm's book on treatment for PCa. I liked the format of the book where he presented many topics using a question and answer style so it reads like a patient asking the questions of their Doctor.

I just started Strum's book and appreciate the fact that there are charts and pictures, all in color, which adds to the discussions in only the way a visual can.

While all the books are tending to run together in the information presented, each has their positives and each presents information in a slightly differnt manner which adds to the research on options we all have to make.

I've also researched some alternatives for staying healthy long-term, as well as what to do short-term before I make my treatment decision. I decided to stop taking a multi-vitamin because of the amount of B vitamins, including Folic Acid. Reports are indicating that Folic is like gas to the PCa fire, so I'm stopping vitamins. I will continue on 1000U of D-3 and I've added an Omega-3 since, as a polyunsaturated, it helps control the bad fats (saturated) in the system. I added some Flaxseed to my routine and will also look into soy. I am continuing to take FloMax and Avodart so that I keep my prostate at a reduced volume so removal will be easier and potentially less invasive to surrounding tissue.
December 1, 2009:

I had my final meeting with my urologist today to go over my test results one more time. I asked about the biopsy results and he's confident (absent any other pathological results) that I'm in a good position for long term recovery. We discussed my two preferred treatment options, surgery and seeds. The Doctor said that if it were him, given my PSA, Gleason, age and biopsy, he'd select surgery because of the long term survivability and salavage options. He said seeds were also an option, but that the long-term studies do not have as much data supporting long-term results and that incontinence and impotence seem to get progressively worse with time. His opinion was radiation (including seeds) are a good option, but a better one for people more advanced in age. We talked briefly about ProstRcision out of RCOG in Georgia - he was aware of the procedure and quite strong about the presentation of the data to favor their practice. While I used the word "skewed," he used the word "voodoo!" I asked about nerve sparing considering the location of my cancer and he said he'd recommend only sparing one side. We both discussed our frustration with the lack of current information and that it seems data and studies date to 2004 and before. With new studies being released almost weekly, it seems those coming after me may have better information on which to base their decisions. We completed our discussions and I set an appointment with a Doctor in the practice who does robotic.


Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 11/8/2009 9:02 PM (GMT -6)   
hello defender, and welcome to HW and out little world. Well, it sucks that you got a PC dx, all you need to be here. But its a great gang here, both men and women.

Good news is that they are calling it a Gleason 6 at this point, fairly low core percentages, should leave you with plenty of options.

Please keep us posted of your journey, and if you need help and or support, we are here for you.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 11/8/2009 9:20 PM (GMT -6)   
Welcme. Your post brings back the memories to all of us. Something about them saying that C word that really gets your attention. You kind of think it must be a bad dream. Couldn't be you. Only old people get cancer.

Well, it is us, and now we must deal with it. From the biopsy, I am inclined to think that you have some time here to resarch the options, make sure you know the pros and cons of each option, and then set about doing it.

This site will prove to be one of the best sounding boards you will ever find. You will find men from every walk of life, with every diagnosis, and probably almost every treatment you can find.

There is no need to panic, or rush into anything. If your PSA was a little lower, I would even suggest you have Active Survelliance as an option, but you may not find that advisable, altho with some Hormone Therapy, you may be able to buy some time as well.

Kepp us in the loop, there are no stupid questions, and we will all try to help you through this.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 11/8/2009 9:42 PM (GMT -6)   
Welcome here I know that you will find much more info that you ever wanted to know....You review of the diagnosis process brings back vivid memories to me...

Read as much as you can on the board. I am sure that you will find someone on the board in your area that can recomend a Dr. to you.

Good luck with you quest. Never hesitate to ask questions here. We all battle the same monster!

Jeff T
Cajun Country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.

Forum Moderator

Date Joined Sep 2008
Total Posts : 4271
   Posted 11/8/2009 9:53 PM (GMT -6)   

Dear defender:

Sorry you have to be here but this is a great place for advice and support.  In NoVa one of the most outstanding urologists is Dr. Walter O'Brien, of "The Urology Group".  Here is their web site:

He is well known and rated one of the DC areas "Best Docs".  He uses Bostwick Labs in Richmond - one of the nation's best.  One of the reasons I recommend him is that, even though he is a surgeon, he will give you an even handed persepective of your options...including seeding which I did.

Additionally, of course, you can always go to Hopkins and be assessed in a multi-disiplinary setting.

If you want to know more about my treatment experience, feel free to click the link at the end of my signature.

Good luck and please let us know how you progress.


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 11/8/2009 10:08 PM (GMT -6)   
Greetings, Defender.  Welcome to the forum that no one wants to be a part of.  From the sounds of things you have lots of time to explore all your options - and you probably have several options.  Do the research - this forum will help - and make your decision and then don't look back.  I don't know much about Northern VA but I am in Richmond and when I researched surgeons I came up with a good one - I like him personally and he was very well respected professionally.  He does about 6 a week and has been doing that for about 20 years.  As you can see from my stats in the signature I have had virtually no issues with incontinence and ED and am very grateful for that.  I attribute most of it to the skill of my surgeon.  If you decide you are interested in coming a few miles to the south let me know and I'd be glad to put you on to my doc.  David
Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 11/8/2009 10:09 PM (GMT -6)   
Nice to see you have a great sense of humor, too. Alot of us would love to have had your stats vs. what our biopsies have shown. The likely hood of your scans showing any PCa with those kind of stats is very, very low. Your options are wide open. Suggest you read "A Primer on Prostate Cancer-the empowered patients guide" Dr. Strum, along with other books, Surviving Prostate Cancer and many others, get well rounded info before jumping into a treatment. It probably took many yrs. for your PCa to get to the level it is today, hope that puts a perspective on it. Check out for info and patient/mentor experiences-histories and read all about others journey and information. Also, has a wealth of info on all phases of PCa.

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 11/8/2009 10:39 PM (GMT -6)   
Welcome defender! Sorry you have to be here, but you have definitely come to the right spot! We have an incredible support group here and I have no doubts you will get all your questions answered and then some. PLease keep us posted in your journey and let us know how we can continue to help!
Father's Age DX 62 (now 64)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Oct. 9, 09 PSA <.01 Last Lupron Shot
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2460
   Posted 11/9/2009 3:22 AM (GMT -6)   
Defender, You are not alone when PC gets your attention. It is a word no one likes to hear. In your case, the fact that it is a Gleason 6 allows you to research your options. Keep us posted. Good luck
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1

Veteran Member

Date Joined May 2009
Total Posts : 739
   Posted 11/9/2009 7:46 AM (GMT -6)   
Sorry you had to join our club, but it appears that you have a good doctor who is doing all the right things to catch this thing early. You asked for recommendations in NoVa, and Tudpock recommended Dr. O'Brien. I second that recommendation if you choose seeds (or even if you don't), for he is an excellent doctor. I met with him but for my particular numbers, he didn't recommend seeds alone, he thought I should also have IMRT and possibly hormone therapy. I have a good friend who was at an earlier stage, and used Dr. O'Brien for seeds alone, and had great results.

In my case, after interviewing many doctors I chose da vinci surgery. If you choose to go that route, I can highly recommend Dr. Simon Chung of Dominion Urology, who operates out of Inova Fairfax. He has done more than anyone in NoVa, close to 500, and is listed in all of the top doctors books. I received recommendations for him from other doctors I interviewed, which says something. Every case is different, but I had excellent results with Dr Chung, was continent right away, and am pretty much back to normal, except for residual ED that is slowly improving. Most importantly, he achieved negative margins with a pretty advanced situation, Gleason 4+3 with some 4+4 and a bit of extracapsular extension. Here is the web site:

Best of luck with whatever you decide.
Age 64 yrs
DX 5/2009
8 out of 12 cores positive
PSA 5.6
Gleason Score 3+4=7
Stage T2a
Da Vinci Surgery 08/07/2009
Upgrade Gleanson Score 4+3=7
Stage pT2c
Neg Margins and Nodes
Extracapsular extension noted but neg Extraprostatic Extention
Dry immediately
First PSA 11/3/09 <0.1

Regular Member

Date Joined May 2009
Total Posts : 215
   Posted 11/9/2009 8:57 AM (GMT -6)   
Hi Defender,

Welcome to our group. You are in the right place for support and advice. Looking forward to hearing about and sharing your journey with PCa.

Keep well,

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 11/9/2009 9:47 AM (GMT -6)   
Hi Defender, welcome, but as the others said, sorry you have joined our club.

I'm a bit of a broken record with new members as I always advise getting a second read of your slides. Pathology is an art as well as a science. In my case a second read made a difference in my treatment decision.

I'll be watching for your next post and an update.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week. 
Feel free to email me at:    

gold horse
Regular Member

Date Joined Nov 2009
Total Posts : 360
   Posted 11/9/2009 10:12 PM (GMT -6)   
tongue  Hi defender,five years ago I was in the same place as you.the only difference my psa=4.5
I was 46 years my doctor adviced me for surgery,and since I want the cancer out of me.
thanks God is been five years and psa=0.04 good luck to you and do your homework.
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09

Regular Member

Date Joined Nov 2009
Total Posts : 98
   Posted 12/10/2009 7:25 AM (GMT -6)   
December 7, 2009:

I was reading a reply by JohnT and he mentioned a way to calculate the size of your tumor. Some research and using the internet wayback machine located Strum's Tumor Volume Calculator. I plugged in my stats and I believe it's telling me my tumor is under .5cc.

Patient name D 3
Enter Date------------------- > 12/8/2009 Enter Gleason Score Right lobe ----> 3 Tumor Volume (TV) at RP
Enter Total PSA ----------- > 8.7 Enter cores positive Right lobe ----> 4 and Cure Post RP after Stamey et al.
Enter Trusp Volume----- > 32 Enter Gleason Score Left lobe ----- > 3 TV at RP # pts. # cured % cured
Volume fraction of cancer -> 0.02 Enter cores positive Left lobe ---- > 0 <.5 cc’s 17 16 94
PC volume calculated------- > 0.49 .5-2 cc 91 73 80
PSA benign ------------------ > 2.112 GS R x # cores positive on right --- > 12 2.0-6.0 129 65 50
PSA PC specific -----------> 6.588 GS L x # cores positive on left -- --- > 0 6.1-12 49 11 22
Organ Confined PC probabilty: 90% Total of above 2 items ---------------- > 12 >12 32 2 6
Predicted 20 mo. Post-RT freedom Total # of positive cores ------------ > 4 Totals 318 167
from PSA Failure Weighted G score ------ > 3
by calculated volume --------------- > 92% Weighted G grade ------ > 1.50
by volume fraction ------------------ > 88% PSA Leak into serum --- > 13.33

December 10, 2009:

I head off for additional consultations today. I'll be meeting with a Doctor (highly recommended from a forum member) in Richmond this morning and a Doctor who does Robotic this afternoon. I'm trying to get a consult also with Snuffy Meyers as well as one Doctor out of Johns Hopkins. I have to say that keeping a record of this is in itself theraputic, it just helps to put thoughts and words to the electronic paper. I'll also say the perspective added by the forum memebers and their advice and answers is incredible. It really does help when you're trying to understand all the research and reading. I'll be asking the Doctors these questions, developed with the help of the members and their posts:
1. What is your assessment of my condition?
2. Can you calculate the approximate size of my tumors(s)?
3. Can you tell how close to the margins my positive cores were?
4. Do you think there is any seminal vessel involvement?
5. Is it possible I have transitional PCa?
6. What is your estimation that my cancer is contained within the prostate?
7. If you were in my position, what treatments would you consider?
8. Which of the treatments would you select if you were in my position? Why?
a. If surgery, am I a candidate for nerve sparing? If yes, Bilateral of unilateral?
b. How will surgery affect my continence?
c. How will surgery affect my sexual quality of life and how will you treat it post surgery?
d. How many of these surgeries have you performed?
e. How may do you perform a year? How many in a week and per day?
f. Do you have cure rate statistics? Or recurrence stats?
g. Do you have incontence and impotency statistics?
h. When should I expect to regain continence and potency?
i. What role during the surgery would a resident or intern perform?
j. Would other physicians be involved in my care and what would be there roles?
k. If surgery fails, what are my options?
l. Would you recommend I wait and undertake a watchful waiting approach?
m. My final decision may take another 4-8 weeks, should I have a hormone shot in the interim?
9. How long will my surgery take and what will it involve?
10. How long would you suspect my recovery will take and what should I be prepared for?
11. How should I prepare for the surgery?
12. What should I be prepared for pre and post op?
13. What are the side effects and how do you treat them?
14. What are the probabilities that I will experience these or any side effects?
15. If I experience any complications, when is it that I should call you?
16. What follow up treatment or care do you recommend?
17. I’ve been on Avodart since September, there are new studies indicating Avodart may have a role in reducing the advance of cancers – can you comment if taking Avodart may skew my readings or affect my decision?

My wife and I drove down to Richmond and first met with Dr. William Morgan of Virginia Urology (highly recommended by another forum member). The Dr. came out ot the waiting room to great us and then took us for coffee, then to his office to chat. He had already familiarized himself with my case and stats and began by detailing my stage and what treatment options were available and the pros and cons of each. We spoke about my specifics and talked through a surgery option. He then answered, in detail, all my written questions. It was a funny moment when he got to the How many of these Procedures have you Performed question - he paused and said he didn't know, but it was not a statement that caused us worry, just the way he paused and thought about the question - he thought for a moment and said he could look it up, but that he's done well over 1,000 open procedures. We left the office after an hour and 15 minutes feeling very comfortable with the Doctor.

We then drove back up to Stafford to have an afternoon meeting with a Dr. from my current urology practice (okay, we did stop and spend an hour in the HUGE Bass Pro Shop right outside of Richmond). We met with the Doctor and I have to say we were first taken by the fact that they took us into a medical treatment room for the consultation versus an office (which I knew they had since I'd been it it previously). The Dr took his time, even though it was the end of the day, and led us through the treatment options, his experience and then answered the questions I had. My wife and left , again, feeling confident in the Dr but his level of expertise (100 robotics) was not where would have liked him to be.

My wife and I discussed the consultations as well as all the treatment options over the next couple of weeks - she left the ultimate decision to me and I elected for an open procedure with Dr. Morgan. I scheduled the surgery for 3 Feb 2010.

February 2, 2010: My wife an I packed up and drove down to Richmond since we have an early showtime at St. Mary's Hospital (5:30am). We showed up on the 3rd and were subject to a very efficient pre-op. I was in pre-op meeting with the Dr and the surgical team as well as answering a host of questions making sure I was who I was supposed to be and that the correct procedure was scheduled. The nurse put an IV into my hand and shortly afterwards they put me to sleep (just before 8am). I woke up in recovery at 10:10am and then began some fun as the bed in the private room I was fortunate enough to have received was not ready. Thus began a 6-hour wait in recovery. Being on my back that long caused my back to really ache, my back hurt more than the surgery! I had two morphine shots in recovery and those fixed me right up. I was wheeled to the room at 5pm and spent a few hours with the wife before she went off to the hotel room. I was up that night and walking around the room, albeit only a couple of times. The rest of the stay was pretty uneventlful, up walking, up at least twice a night for vital signs and once for blood work, then more walking. I passed gas on the 4th, but it was a feint, the real gas wasn't until Friday the 5th - what a relief that was. The morning of the 5th I met with the Doctor and he agreed I could be discharged. The wife and I were pretty happy since it was snowing in Richmond on what was the beginning of 24 inches of the white stuff and we had to drive an hour and a half back to Stafford (the ride was easy though). I started recovery at home and I have to say it was pretty uneventful. There was no real pain and I kept to my regiment of walking. I also made sure I pushed fluids (water and a 50/50 mix of water and cranberry juice) as well as a very soft diet (soups, jello, cereals, etc.) until my bowels were working again and with no constipation. I was taking an antibiotic and Hydrocodone, but did not really need the hydrocodone except at night. I was able to manage the external bag easily and switched to the leg bag also without an issue.

February 12, 2010: The wife and I drove back to Dr Morgan's office for catheter and staple removal and my path report. Doctor Morgan was very pleased with the report and my recovery. Surgical staples and catheter removed (my opinion is these were easier (painwise) than the removal of JP) and the nurse placed about 8 large butterfly bandages over the incision. Here's the report on my dual nerve sparing open procedure:

Prostate Size: 39gms
Lymph Node sampling: No lymph nodes present (Doctor, while in surgery, made decision not to take any nodes)
Histologic Grade: Gleason Score 3+3(6)
Percentage of Prostate Involved by Tumor: 5%
Extraprostatic Extension: Not Identified
Seminal Veicle Invasion: Not Identified
Margins: Uninvolved by invassive carcinoma
Lymphovascular Invasion: Not Identified
Perineural Invasion: Present
Pathologic Stage: pT2c pNX pMX

I go back March 19th for my first post op PSA test.

February 15, 2010: Recovery is going well, almost too well; no pain management issues and I'm continent with the exception of sometimes when I strain, like a cough or a sneeze. I do get up during the night, but my pad is dry. My bladder doesn't seem to hold as much as before as I'm going every 2 hours, but I'm sure that will get better with time. I also swear I had a partial erection one night. I feel VERY fortunate to be weathering the storm so well considering some of the stories on the forum.

February 17, 2010: Good new, not so good news. Good news is I did have full erection last night without the aid of any chemicals, looks like ED may not be an issue. Not so good was that I did way too much yesterday by lifting light loads and going up and down the stairs far too many times - paid the price by leaking badly which had me use about 5 pads during the day. Did far less today and the result was back to hardly any leakage at all (still have some leaks when I sneeze or when I strain to get up, cough, etc.) Pain is almost all gone and the butterfly bandages are about to come off by themselves.

March 19, 2010:  I hereby submit my application for the "ZERO" club! I had my 6-week follow-up with my doctor today in his Richmod offices. I was escorted in and had some blood drawn, then waited in the exam room and spoke with an intern for a few minutes. Dr. Morgan came in, shook my hand and told me my PSA was undetectible, being less than 0.1 (apparently their lab is right on site so they do the testing right away). Of course I was elated! We spoke for a awhile and I asked about the more exacting exams that provide potentially better visibility on a rising PSA and doubling times. He was frank and told me he does not use them because of PSA anxiety and that their value may not be what many people believe. He continued by saying my pre-op stats and findings during surgery, combined with my post-op pathology report are all postivie indicators and that he believes my PSA will remain undectable. I will go back in 3 months for another PSA.


July 10, 2010:  I had my 6 month follow-up Thursday and was very relieved to have another Zero. I know I have some time to go to really have some calm, but I couldn't be happier with the results so far. As some of you know, I opted for an open procedure with a surgeon who performed about 1400 surgeries. I'm leak free and the hydraulics (an old Greaseman reference for anyone who remembers him from the radio airways in DC) are working just fine. I truly feel blessed and am continually thankful, especially for the advice and friendship from the folks here at the "Well." Cheers My Friends!



Post Edited (defender3) : 9/21/2010 8:14:12 AM (GMT-6)

Regular Member

Date Joined Dec 2009
Total Posts : 97
   Posted 12/11/2009 1:10 PM (GMT -6)   
Welcome to HW defender.This is my escape from my worst enemy too much time to think! Sorry you had to join us but since you did this was one decision that was pretty easy to make(joining HW) and beleive me it was the right one!Take care and I look forward to watching your progress through the upcoming months.

age 55dx 12-2008,psa at biopsy 8.6
biopsy 12/12 gleason 3+4=7
da vinci surgery 6-09 by DR. John W. Scott (my hero)
Hospital 3 days cath 7days still leaking from cough(bad lungs)
still have ed may be the hormones.
9-09 psa 2.2 hormone inj
10-09 nuclear bone scan no results yet I will have gold markers placed 12-29-09
start rad 1-10-09
organ confined
extracapsular seminal vesicle involvement
lymph node involvement

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